Inspection on 14/09/06 for Bank House Nursing Home

This inspection was carried out on 14th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bank House Nursing Home 04/11/08

Bank House Nursing Home 15/11/07

Bank House Nursing Home 02/03/06

Bank House Nursing Home 11/08/05

Bank House Nursing Home 10/01/05

Bank House Nursing Home 05/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bank House Nursing Home Brandlesholme Road Bury Lancashire BL8 1DJ Lead Inspector Mike Murphy Unannounced Inspection 14th September 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bank House Nursing Home Address Brandlesholme Road Bury Lancashire BL8 1DJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 764 4358 0161 762 9825 bank house8700@tiscali.co.uk Mr Alan Stott Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (1) of places Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total of 43 places there can be a maximum of 42 nursing places, 1 18-59 nursing place and up to a maximum of 20 residential places 11th August 2005 Date of last inspection Brief Description of the Service: Bank House Nursing home is situated just outside the centre of Bury and is readily accessible by car and public transport. The home is registered with The CSCI to provide general nursing and personal care for up to 43 service users. The manager of the home is a qualified nurse, and qualified nurses are on duty 24 hours a day. Fees at time of this inspection; £350.00 to £433.00 (information provided by home. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 14th of September 2006. The inspection took place over eight hours. The inspector spoke to 5 of the 39 residents and 3 relatives, toured the premises, and inspected care and other records maintained at the home, and spoke with the home manager her staff and the registered provider. Residents at the home appeared to be looked after appropriately and generally content in their environment. A number of issues requiring attention were identified and these are detailed below and in the main body of the report What the service does well: What has improved since the last inspection? All the requirements that were made at the last inspection to improve the services provided to residents have been complied with appropriately. A rolling programme of the refurbishment of the environment – particularly of resident’s bedrooms – is in progress. Residents and their relatives spoke very positively of these improvements. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. No prospective resident is admitted to the home without care and support needs being assessed appropriately. EVIDENCE: The inspector was informed that before residents are admitted to the home the manager carries out an assessment of the prospective resident’s needs in consultation with the resident, their relatives and relevant health care and social care professionals. The purpose of such an assessment is to assist the prospective resident (and their relatives) in their consideration of how appropriate a placement at the home would be and enable the nurse conducting the assessment if the home will be able to meet the prospective resident’s needs appropriately. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 9 The care records for the last three residents admitted to the home contained a record of assessment for 2 of the 3. The manager informed the inspector that the third person had an assessment but could no locate the record at the time of inspection. It is also recommended that the record of assessment for all residents to the home be made available for inspection Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The health and personal care residents at the home receive is appropriate and is meeting the expectations of residents and their relatives. EVIDENCE: The care records of 6 residents were inspected on this occasion. Most care records contained care plans that were initially based on the preadmission assessment that is referred to earlier in this report – although it was evident that in the case of 3 recently admitted residents care planning was incomplete. Care plans that were in place addressed the health, personal and social care needs of residents and were generally evaluated at least monthly. However a number of these care plans have been in place for a number of years and require full and detailed review. Risk assessments, that seek to protect resident’s health and safety were also generally recorded in respect of residents skin integrity, mobility, and nutrition (including weight monitoring) Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 11 and other relevant areas and were also in the main evaluated at least monthly. However a number of risk assessments and their evaluations were incomplete. Written daily statements are made in respect of each resident. However these were not always timed – it is strongly recommended they be so. The inspector is of the view that the system of maintaining care records is in need of review and a system of monitoring their appropriate completion should be instituted by the manager. on the day of inspection residents appeared to have been cared for appropriately and to be content in their environment. Residents and their relatives confirmed that the health care needs of residents were being properly met. All residents are registered with a local GP and it was evident that all were enabled to access optical, chiropody, dental, and other specialist services as they required. Relatives said they were kept informed of all significant changes in their relation’s condition. All medical consultations/examinations take place in the privacy of the resident’s own bedroom. A local pharmacy provides a full pharmaceutical service to the home that includes professional advice on medicines. The arrangements for the receipt, recording, storage, handling, administration and disposal of resident’s medicines were appropriate. The qualified nursing staff are responsible for all aspects of managing medication in home. Medication administration records had been completed appropriately. The registers for controlled drugs had been completed appropriately. The inspector is of the view that the policies operated by the home in relation to medication should be reviewed/updated. Discussion with residents revealed that they felt they were treated with respect and that their right to privacy was upheld. Comments made included; ‘the staff are nice and kind to us all’, ‘I am able to make my own mind up about what I do and what to join in’, ‘staff treat you as a person’, ‘ when the doctor comes to see me he examines me in my bedroom’. Residents reported that they were asked how they preferred to be addressed when they were admitted. Residents who are coming to the end of their life are appropriately and sensitively supported, and the staff team are, led by qualified nurses who are in providing and supervising such care. The home utilise the integrated care pathway for the care of the dying that has been developed in conjunction with local health services and delivered by the home staff supported by a multiprofessional team of health care professionals. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were of the view that they were very well supported by staff to participate in social activities and are able to retain the ability to make personal choices. A variety of views expressed about the food but generally comments were positive. EVIDENCE: A prominently displayed activities programme was in place in the main lounge of the home that reflected the provision of varied activities daily, occasional entertainers coming to the home and trips out. Residents identified the things they enjoyed and felt they were enabled to participate or not as they chose to do. And residents are also of the view that the routines of daily life were as reasonable as possible in a communal living setting – it was evident on the day of inspection a significant number of service users had chosen to stay in bed ‘late’. Residents and their relatives report no unreasonable restrictions to visiting at the home – which can be conducted in communal lounge areas or service users bedrooms. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 13 Residents indicated that they are actively encouraged and enabled to retain as much personal autonomy and make personal choices in their daily lives at the home – many have brought items of furniture to further personalise their bedrooms. Menus were balanced, varied and provided reasonable choices. Three meals a day are provided plus supper. Meals are served in a pleasant and appropriate dining area in the main lounge. Meal times are reasonable and as flexible as they can be in such a setting. Lunch was observed and sampled on the day of inspection. This was a hot and substantial meal and staff assisted and served residents their meals appropriately. Residents indicated that whilst they were in the main happy with their food provision and stated that if they did not like what was on the menu on a particular day a reasonable alternative was provided and they felt comfortable enough to ask for this. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents and relatives spoken to said they felt comfortable enough to make a complaint if they felt the need and knew how to do so. Written guidance and training arrangements ensure that staff members have a knowledge of abuse and protection – however these need to be updated to maximise safeguards to protect the welfare of residents. EVIDENCE: The complaints procedure was prominently displayed and also is available in the ‘Service users guide’ that is provided for resident’s information. Residents spoken to expressed the view that any concerns/worries they raise are responded to swiftly and rarely turn into formal complaints. A complaints log/incident log is maintained. There were no complaints logged since the last inspection (March 2006). Bank House has an abuse policy for elderly persons. However this policy is in need of review and updating and it is strongly recommended that a copy of the interagency abuse policy adopted in Bury supplements any policy devised by the home. It is also noted that whilst some staff have been provided with protection of vulnerable adult training this needs to be extended to those who have not had such training or who require refresher training. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were clearly happy with the standard of the home’s environment and the comfort it provides. EVIDENCE: Bank House provides a suitable environment for the provision of ‘residential’ and ‘nursing’ care. The building and grounds appear to be maintained appropriately. Since the last inspection in March 2006 a ‘decking’ style patio area that is accessible to all residents has been provided – and this has proved very popular with residents and their family/friends in the summer. Communal lounge/dining areas within the home were clean, warm and comfortably/appropriately furnished. However an office type desk has been placed in the large lounge area and the inspector is of the view that this detracts from the ‘domestic’ character that such a room should possess. Its place in the room should be reviewed. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 16 WC and bathing/showering facilities are provided that were clean, appropriately ventilated, equipped and that have been suitable adapted to meet the needs of residents. A small number of resident’s bedrooms have ensuite facilities. Suitable adaptations have been made to meet the needs of residents and specialist equipment for example bath and portable hoists have been provided. Individual resident’s specialist needs are met following referral of the individual resident to the relevant health care professional for example for wheelchairs or a walking aids. 14 resident’s bedrooms were inspected on each unit. These were clean, appropriately furnished and equipped. All the bedrooms seen were highly personalised and it was evident that an ongoing programme to refurbish all resident’s bedrooms is progressing well. Residents spoke very positively about the comfort of their rooms and said they could go to them when they wished and that their privacy was respected. The home is centrally heated throughout, and naturally and mechanically ventilated. The inspector was informed hot water temperatures are controlled by thermostatic mixer valves. The home was very clean and free of malodour throughout and is serviced daily by domestic cleaning staff. Appropriate procedures and equipment were in place to prevent the spread of infection. A laundry in the basement services the laundry needs of the whole home. This was not inspected on this occasion. However comments from residents and relatives were positive about the laundry service provided. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Resident’s were of the view that staff were meeting their needs appropriately and staff are subject to an appropriate recruitment procedure that is consolidated by supervised induction training when appointed. EVIDENCE: Inspection of staffing rotas provided by the home indicated that staffing provision at the home complied with the current minimum requirements that apply to care homes for older people. Discussion with the manager at the home indicated that she was of the view that current staffing levels at the home were appropriate to meet the dependency levels of resident’s. Inspection of 3 staff personnel files revealed that these contained an application form (including health declaration), 2 written references, a Criminal Records Bureau check (including a ‘POVA first’ check), proof of identity and evidence of induction training and further training. NVQ 2 and 3 training in health and social care is being provided for staff. At the time of inspection the manager stated that 25 of care staff had achieved the NVQ 2 qualification or above. The home is aiming to achieve the 50 required by the National Minimum Standards through a process of ongoing NVQ training for new staff. Also a wide range of appropriate and ongoing training in moving and handling, abuse, basic food hygiene, fire safety and Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 18 other relevant topics is provided to staff at the home. Although it is noted that abuse training does need to be extended to cover all staff. It is also strongly recommended that induction training provided at the home be reviewed with a view to meeting the Skills Council workforce training specification. The home is also accredited to accept student nurses as part of their statutory training. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Bank House is appropriately managed by the manger, a qualified registered nurse with many years of experience in general nursing and care of the elderly. EVIDENCE: The home manager was undergoing the process of registration with the CSCI at the time of this inspection. She is a very experienced registered nurse and has recently completed an NVQ4 in management. Discussion with residents their relatives and staff employed at the home indicated that the manager is very accessible, approachable, provides leadership, is supportive and is very Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 20 aware of what is happening in the home. The manager is supported in her management duties by the registered person and administrator. However the manager is working in both a supernumerary capacity and on occasions as a ‘nurse’ in the home. This needs to be monitored carefully by the registered person and the manager to ensure that sufficient time is being given to managing what is a moderately sized busy nursing and residential home. The manager informed the inspector that the home was introducing a new system of quality assurance that will seek to evaluate the quality of the services provided at the home. This needs to be implemented as soon as possible to ensure the views of residents and their relatives/representatives are established. Also the policies and procedures that are operated by the home are now between 4 and six years old and in need of review and update to ensure any changes to legislation and good practice is recognised. Residents, relatives and staff report that the manager and her senior staff operate an ‘open door’ policy that enables people to raise and discuss any areas of concern quickly and comfortably. Records in respect of fire safety equipment, fire drills, electrical safety, gas safety, safety of lifting equipment, clinical waste (including waste medicines) removal, and the regulation of water temperatures were inspected. These were found to be satisfactory. The arrangements for the management of residents personal allowance monies (where these are managed by the home) were appropriately documented and regularly audited. Residents confirmed to the inspector that they were able to access monies when they required them. It is noted that arrangements are in place where resident’s personal allowances can be banked in a ‘residents’ account. This account accrues interest. The registered person needs to determine how the interest that is accrued in this account is distributed equitably. Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement That a record of the preadmission assessment that is conducted on all residents admitted to the home is retained as part of the care records of individual residents. That the CSCI is informed in writing that all residents care plans/risk assessments reflect how their health and welfare needs are to be met and are formally reviewed/evaluated at least monthly. That the CSCI is informed in writing what arrangements have been made to ensure all staff at the home are provided with protection of vulnerable adult training. That the CSCI is informed in writing that an appropriate system for evaluating the quality of the services provided at the care home has been established – as detailed in Regulation 24. That the CSCI is informed in writing what arrangements have been or are being made to distribute interest accrued in the DS0000017315.V288806.R02.S.doc Timescale for action 31/10/06 2 OP7 15 31/10/06 3 OP18 13 31/10/06 4 OP33 24 31/10/06 5 OP35 20 31/10/06 Bank House Nursing Home Version 5.2 Page 23 homes ‘residents’ account to individual residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP3 OP20 OP30 OP33 Good Practice Recommendations That pre-admission assessment records are completed in more detail to fully reflect the care and support prospective residents will require. That the office type desk that has been put in the main lounge is removed and that the reason for its initial placement is reviewed. That induction training provided at the home is reviewed with a view to meeting the Skills Council workforce training specification. That all the policies operated by the home are reviewed and updated to reflect changes in legislation/good practice Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bank House Nursing Home DS0000017315.V288806.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!